Free Functional Muscle Transfer
Original Editor - Misha Ahir
Top Contributors - Misha Ahir, Kim Jackson and Vidya Acharya
Description
Free functional muscle transfer (FFMT) is an advanced micro surgical procedure that replaces damaged or missing muscles with functioning muscles from elsewhere in the body.[1]It is a useful technique, particularly for patients in whom the motor unit has become irreversibly denervated, and where there is no adequate local or regional donor tissue that can be sacrificed without unacceptable morbidity.[2] Gracilis is the most common muscle used for upper limb reconstruction.
Indication
Functioning free muscle transfers are indicated for the reconstruction of major segmental skeletal muscle loss that results in a significant functional deficit.The skeletal muscle loss is replaced by healthy normal muscle that is transferred from a distance and revascularised and reinnervated. most common conditions include:
- Brachial plexus injuries: FFMT can restore movement to the upper extremities in patients with brachial plexus injuries.[3]
- Muscle ischemic contracture: FFMT can help with muscle ischemic contracture.[1]
- Tumor resection: FFMT can help with muscle defects after tumor resection.[4]
- Lower extremity reconstruction: FFMT can help reconstruct lost muscle units in the lower extremity after trauma, compartment syndrome, or severe nerve injuries.[5]
Contraindications:
- No acceptable donor nerve to innervate the transferred muscle, inadequate recipient vessel for micro anastomosis.
- the patient is unable to participate in and complete a time-consuming rehabilitation program for FFMT.
- poor passive ROM of the joint across which muscle has to act.
- lack of antagonist muscle function.
Pre-Operative
Pre-requisite for FFMT
- Stable soft tissue coverage over the recipient site
- Full passive ROM of the joint
- Antagonist muscle function present
- Tendon with adequate gliding
- Acceptable or no donor site morbidity
Donor Muscle option: Gracilis , Latissimus dorsi, rectus femoris, pectoralis major, tensor facia lata, serratus anterior
Post-Operative
The post-operative monitoring for any ischaemic insult or flap intake by the surgical team. Post-operative immobilisation is often performed for weeks(usually 6 to 8 weeks) and is guided by a surgeon.[1]once the cast is removed, a splint is advised. controlled stretching and passive ROM to main joint mobility is initiated. Muscle activation exercises and electrical stimulation are performed regularly.[6]Physiotherapy sessions are short and ends with muscle fatigue. later stage functional exercises are incooperated. it may take from months to years for functional recovery.
Nearly half of the FMMT for upper limb reconstruction achieves a power of greater than 3 (MRC grading).
Goal :
- Gain a useful or functional range of motion
- Provide adequate strength for functional activities
The patient needs to follow comprehensive and long-term physiotherapy follow-up.[4]
References
- ↑ 1.0 1.1 1.2 Fischer JP, Elliott RM, Kozin SH, Levin LS. Free function muscle transfers for upper extremity reconstruction: a review of indications, techniques, and outcomes. J Hand Surg Am. 2013 Dec;38(12):2485-90.
- ↑ Reed AJ, Claireaux HA, Wormald JC, Thurley N, Shirley R, Chan JK. Free functional muscle transfer for upper limb paralysis - A systematic review. J Plast Reconstr Aesthet Surg. 2022 Mar;75(3):1001-1017. doi: 10.1016/j.bjps.2021.09.038. Epub 2021 Oct 23. PMID: 34986998.[1]
- ↑ Bishop AT. Functioning free-muscle transfer for brachial plexus injury. Hand Clin. 2005 Feb;21(1):91-102. doi: 10.1016/j.hcl.2004.10.005. PMID: 15668069.[2]
- ↑ 4.0 4.1 Seal A, Stevanovic M. Free functional muscle transfer for the upper extremity. Clin Plast Surg. 2011 Oct;38(4):561-75. doi: 10.1016/j.cps.2011.09.001. PMID: 22032586.[3]
- ↑ Chi D, Raman S, Tawaklna K, Zhu WY, Keane AM, Bruce JG, Parikh R, Tung TH. Free functional muscle transfer for lower extremity reconstruction. J Plast Reconstr Aesthet Surg. 2023 Nov;86:288-299. doi: 10.1016/j.bjps.2023.09.041. Epub 2023 Sep 15. PMID: 37797377.[4]
- ↑ Functional muscle transfer for restoration of elbow flexion: a review.Plastic and Aesthetic Research